Factors Affecting Psychosocial Adjustment in Persons With a Recent Ostomy.

PURPOSE: The aim of this study was to examine the influence of personal and clinical factors on psychosocial adjustment in persons living with an ostomy for less than 1 year. DESIGN: A cross-sectional survey. SUBJECTS AND SETTING: The study sample comprised 183 adult individuals who had a colostomy, ileostomy, or urostomy for less than 1 year, residing in the Northeastern United States. METHODS: Data were collected from May through November 2018 using 2 instruments: a sociodemographic questionnaire and the Ostomy Adjustment Inventory-23 (OAI-23). The OAI-23 items measured 4 psychosocial subscales: acceptance, anxious preoccupation, social engagement, and anger. Data were analyzed using analysis of variance, multivariate analysis of variance, Cramer's V correlations, and multiple regression. RESULTS: Univariate analysis indicated that factors influencing psychosocial adjustment to an ostomy include age, assistance with care, educational background, stomal type, body mass index, ostomy height, preoperative education, and stoma siting. Multivariate analysis of variance identified that those who reported independence with ostomy care experienced higher levels of adjustment in all areas of the OAI-23. CONCLUSIONS: Findings from this study may assist nurses and other care providers to better understand the physical and emotional needs of those with ostomies and to identify interventions to promote optimal health in this population.

United Ostomy Associations of America's Ostomy and Continent Diversion Patient Bill of Rights: An Examination of Best-in-Practice Care for Ostomy Patients.

PURPOSE: The purpose of this study was to examine best practices through utilization of United Ostomy Associations of America's (UOAA's) Ostomy and Continent Diversion Patient Bill of Rights (PBOR) from the perspective of patients and clinicians. DESIGN: Cross-sectional, comparative design. SUBJECTS AND SETTING: The sample comprised 412 patients with ostomies (colostomy, ileostomy, urostomy) and continent diversions (such as J-pouch) and 195 clinicians (physicians, nurses, nurse assistants) residing in the United States. All patients underwent surgery within the United States. Almost half of participants (n = 196/412; 47.6%) had surgery within 5 years of data collection. METHODS: Participants were recruited between 2019 and 2020. Patient data were collected from UOAA's national conference and affiliated ostomy support groups. Clinician data were collected at the 2019 National WOCN Society Conference and through affiliated nursing and medical professional societies. Participants completed a self-administered online or printed survey; items focused on the Ostomy and Continent Diversion PBOR and standards of ostomy care. RESULTS: Among clinicians familiar with the PBOR, 54% (n = 58/106) reported UOAA's PBOR was being used to inform ostomy care. When analyzing the full sample of both clinicians and patients, we found that less than 13% (n = 25/195) of clinicians and 5% (n = 20/412) of patients reported that all 16 of the recommended standards of care outlined in the PBOR were incorporated into ostomy care. Analysis also revealed differences between patients' and clinicians' reports of provision of 14 of the 16 PBOR components. They include a discussion on emotional impact of the ostomy surgery, instructions on troubleshooting potential difficulties with the ostomy, provision of educational materials, and providing information for ordering supplies. CONCLUSIONS: Study findings showed discrepancies between the PBOR standards of care being provided by clinicians versus the care patients reported they received. Findings also indicated variability in the consistency of delivering all components of the PBOR. We assert that further awareness and wider utilization of the PBOR in every health care setting in the United States are needed to provide best care to patients living with an ostomy.

Quality of life of adult individuals with intestinal stomas in Uganda: a cross sectional study.

INTRODUCTION: Intestinal stomas remain important life-saving surgical options in a wide range of gastrointestinal pathologies globally. Living with a stoma has potential to impair the patient's quality of life, often with associated negative psychological effects. OBJECTIVE: To evaluate the quality of life among intestinal stoma patients under Mulago National Referral Hospital (MNRH), with emphasis on psychological effects and effects on family-social interactions. METHODOLOGY: A cross-sectional study carried out at surgical outpatient clinics of MNRH between January and June 2018. Data was collected using Stoma-QOL questionnaire, PHQ-9 and GAD-7 from 51 participants who had lived with intestinal stomas for at least a month. RESULTS: Of the 51 participants, male: female ratio was 4:1 and aged 18-84 years (mean age 44.04+18.47 years). 76.5% had colostomy; 23.5% had ileostomy. Majority (88.2%) had temporary stomas. The overall mean Stoma-QOL score was 55.12+ 17.04. Only about a quarter (24%) of participants had Stoma-QOL scores >70 (best). Most patients exhibited negative psychological effects (anxiety-100%, concerns about changed body image - 96.1% and depression - 88.4%). CONCLUSION: Most participants had low levels of stoma-related quality of life, suffered negative psychological effects and exhibited limited social interactions. This calls for efforts to support Stoma patients adapt beter life.

[Development and Evaluation of Resilience Enhancement Program Applying Mindfulness Meditation in Patients with Ileostomy].

PURPOSE: The purpose of this study was to develop a resilience enhancement program applying mindfulness meditation (REP-MM) and evaluate the effects of the program on post-traumatic stress (PTS), resilience, and health-related quality of life (HRQoL) in patients with ileostomy. METHODS: The REP-MM was developed by combining the resilience enhancement program with mindfulness meditation according to four patterns. The program was developed through identifying patients' needs, reviewing relevant literature, developing a preliminary program, and testing content validity and user evaluation. The participants were 55 patients with ileostomy. We conveniently assigned 27 patients to the experimental group and 28 to the control group. The study was conducted in conducted in a hospital from January 22 to May 30, 2019. The REPMM was provided to the experimental group, and conventional ileostomy care was provided to the control group using a nonequivalent control-group pretest-posttest design. RESULTS: ANCOVA revealed that the levels of PTS (F = 321.64, p < .001), resilience (F = 111.86, p < .001), and HRQoL (F = 31.08, p < .001) in the experimental group were higher than those in the control group when comparing pretest to posttest changes. CONCLUSION: The REP-MM is effective in PTS, resilience, and HRQoL in patients suffering from post-stoma creation crisis. The REP-MM can induce positive self-recognition changes in patients with ileostomy through dispositional, situational, relational, and philosophical interventions. We suggest nurses reduce PTS and improve resilience and HRQoL in patients with ileostomy.

Long-term Follow-up, Patient Satisfaction, and Quality of Life for Patients With Kock's Continent Ileostomy.

BACKGROUND: Continent ileostomy is a solution for patients after proctocolectomy. OBJECTIVE: The aim of this study was to assess the long-term complications and failure rate alongside patient satisfaction, function, and quality of life for patients with a continent ileostomy. DESIGN: This was a retrospective, descriptive cross-sectional study. SETTINGS: All patients were operated in 1 center between 1980 and 2016. PATIENTS: A total of 85 patients received a de novo continent ileostomy in our institution. Sixty-nine patients (80%) had ulcerative colitis, 12 (14%) had Crohn's disease, 2 had indeterminate colitis, and 1 each had familial adenomatous polyposis and anal atresia. MAIN OUTCOME MEASURES: Medical charts were reviewed for reoperations and pouchitis. The 36-Item Short Form, Short Health Scale, and a local continent ileostomy questionnaire were used to assess quality of life, function, and satisfaction. RESULTS: After a median follow-up of 24 years, 67 patients (79%) underwent a total of 237 reoperations, of which 15 were conversions to end ileostomies, that is, failures. Fifty patients (59%) underwent repeat laparotomies, excluding loop ileostomy closures. Nipple detachment was the most common cause for repeat laparotomy, and fistulation was the most common cause for pouch removal. IPAA before continent ileostomy was associated with an increased risk for failure. Crohn's disease was not associated with an increased risk for reoperation or failure. Forty-three patients (84%) reported that they were satisfied. Seventy patients were available for questionnaires, and 50 patients (71%) answered. There was no difference in the 36-Item Short Form between the continent ileostomy population and an age-matched control population. LIMITATIONS: The retrospective, single-center design of the study alongside <100% response rate are to be considered limitations. CONCLUSIONS: Despite large numbers of complications, patients are generally satisfied with their continent ileostomies, and their quality of life is comparable to the general population. See Video Abstract at http://links.lww.com/DCR/B444. SEGUIMIENTO A LARGO PLAZO, SATISFACCIN DEL PACIENTE Y CALIDAD DE VIDA PARA PACIENTES CON ILEOSTOMA CONTINENTE DE KOCK: ANTECEDENTES:La ileostomía continente es una solución para los pacientes después de una proctocolectomía.OBJETIVO:El objetivo de este estudio fue evaluar las complicaciones a largo plazo y la tasa de fracaso junto con la satisfacción del paciente, la función y la calidad de vida de los pacientes con una ileostomía continente.AJUSTES:Todos los pacientes fueron operados en un centro entre 1980 y 2016.DISEÑO:Estudio retrospectivo, descriptivo y transversal.PACIENTES:Un total de 85 pacientes recibieron una ileostomía continente de novo en nuestra institución. Sesenta y nueve (80%) pacientes tenían colitis ulcerosa, doce (14%) enfermedad de Crohn, dos, colitis indeterminada y uno de poliposis adenomatosa familiar y atresia anal respectivamente.PRINCIPALES MEDIDAS DE RESULTADO:Se revisaron los registros médicos en busca de reintervenciones y pouchitis. Se utilizó SF-36, escala de salud corta y un cuestionario de ileostomía continente local para evaluar la calidad de vida, la función y la satisfacción.RESULTADOS:Después de una mediana de seguimiento de 24 años, 67 (79%) pacientes fueron sometidos a un total de 237 reoperaciones, de las cuales 15 fueron conversiones para terminar con ileostomías, es decir, fracasos. 50 (59%) pacientes se sometieron a laparotomías repetidas, excluyendo los cierres de ileostomía en asa. El desprendimiento del pezón fue la causa más común de repetición de laparotomía y la fistulación fue la causa más común de retiro de la bolsa. La anastomosis anal de la bolsa ileal antes de la ileostomía continente se asoció con un mayor riesgo de fracaso. La enfermedad de Crohn no se asoció con un mayor riesgo de reoperación o fracaso. 43 pacientes (84%) informaron que estaban satisfechos. 70 pacientes estuvieron disponibles para cuestionarios y 50 pacientes (71%) respondieron. No hubo diferencia en SF-36 entre la población de ileostomía continente y una población de control de la misma edad.LIMITACIONES:El diseño retrospectivo y unicéntrico del estudio junto con una tasa de respuesta inferior al 100% deben considerarse limitaciones.CONCLUSIÓN:A pesar del gran número de complicaciones, los pacientes generalmente están satisfechos con sus ileostomías continentes y su calidad de vida es comparable a la de la población general. Consulte Video Resumen en http://links.lww.com/DCR/B444.

[Current status of research on short-term quality of life after sphincteric-saving surgery in rectal cancer patients].

Sphincteric-saving surgery (SSS) is currently a hot spot in the treatment of mid-low rectal cancer. Although it preserves the anatomical continuity of the colon and anus, the postoperative functional outcomes and quality of life (QOL) remains to be confirmed. Current studies have shown that quality of life worsens at the first month after surgery, improves within 3-6 months, and stabilizes at about 1 year. The QOL was associated with patient-related factors, tumor-related factors, treatment-related factors and postoperative complications. For patient-related factors, younger patients have worse role function and sexual function but better cognitive function and physical function. Male patients deteriorate significantly in sexual and social function. For tumor-related factors, patients with lower rectal cancer have poorer defecation function. Those with advanced rectal cancer are more likely to suffer from side-effects related to chemotherapy. For treatment-related factors, patients undergoing intersphincteric resection have worse role function, body image and sexual interest. Preventive ileostomy results in the deterioration of role function, body image and sexual interest. Chemotherapy causes taste changes and chest pain. For postoperative complication, patients with anastomotic leakage have worse bowel function and psychological state. Patients with major low anterior resection syndrome and genitourinary dysfunction have worse global health score, social function and role function. In conclusion, short-term quality of life after sphincteric-saving surgery is acceptable. To improve QOL, specific intervention and guidance should be given to patients in this stage. Meanwhile, since many factors influence the quality of life simultaneously, researchers are confused about the questionnaire outcomes. Therefore, more specific and comprehensive tools are needed to evaluate QQL after sphincteric-saving surgery.

The validity and reliability of the Stoma Self-Efficacy Scale: A methodological study.

AIMS: To assess the validity and reliability of the stoma self-efficacy scale for Turkish-speaking individuals with stoma. BACKGROUND: Self-efficacy in stoma care is one of the most important variables requiring compliance for an increase in the quality of life and well-being of individuals with stoma. DESIGN: A methodological study. METHODS: This study used translation and back translation for the scale's language equivalence and expert opinion for the content validity. An expert panel and 10 individuals with stoma evaluated the scale for face validity. The scale's reliability was assessed by internal consistency, Pearson correlation, and test-retest reliability in a sample of 174 individuals with stomas. The scale's construct validity was tested with confirmatory factor analysis and exploratory factor analysis. RESULTS: The content validity index was .96, and Cronbach's alpha was .95. In the test-retest analysis, the intraclass correlation coefficients were high. In the factor analysis, two factors emerged from the scale, and after the confirmatory factor analysis and scale modification, the fit indices of the model were found to provide a good level of validity. CONCLUSION: The Turkish version of the stoma self-efficacy scale is a valid and reliable tool to determine the levels of self-efficacy in individuals with stoma.

City of Hope Quality of Life-Ostomy Questionnaire Validity and Reliability Assessment on a Croatian Sample.

The aim of this study was to validate City of Hope Quality of Life-Ostomy Questionnaire (CoH-QoL-OQ) for assessing the quality of life (QoL) of ostomy patients in the Republic of Croatia. The CoH-QoL-OQ is widely used, but has not been translated or validated so it can be used in the Republic of Croatia. This cross-sectional study encompassed 302 surgery patients with colostomy, ileostomy, or urostomy (182 (60.3%) male and 120 (39.7%) female), whose average age is 59 (M = 59.3, SD = 15.8). The CoH-QoL-OQ was translated into Croatian language using accepted guidelines for translation. Patients were recruited in a telephone conversation, followed by mail containing the CoH-QoL-OQ delivered to the home addresses of the patients who agreed to participate. The collected data were analyzed to verify psychometric properties of the questionnaire on the Croatian sample. All subscales showed high level of internal consistency (Cronbach α = 0.73-0.89). The test-retest reliability indicated a very satisfactory temporal stability (r = 0.99). The Confirmatory Factor Analysis (CFA), showed that the originally established model was not adequate for the data (χ2 = 4237.88, p < 0.01, CFI = 0.540, NNFI = 0.481, RMSEA = 0.113). However, after modification that excluded problematic items, the data showed a better fit with the theoretical model (except for the LR chi-square test that remained statistically significant: χ2 = 1144.28, p < 0.01, CFI = 0.869, NNFI = 0.855 RMSEA = 0.077). We conclude that the CoH-QoL-OQ is a valid, reliable, and reducible instrument for measuring the health-related quality of life (HRQoL) among Croatian patients with ostomy in clinical research and clinical practice.

Cost analysis in a randomized trial of early closure of a temporary ileostomy after rectal resection for cancer (EASY trial).

BACKGROUND: Hospital costs associated with the treatment of rectal cancer are considerable and the formation of a temporary stoma accounts for additional costs. Results from the EASY trial showed that early closure of a temporary ileostomy was associated with significantly fewer postoperative complications but no difference in health-related quality of life up to 12 months after rectal resection. The aim of the present study was to perform a cost analysis within the framework of the EASY trial. METHODS: Early closure (8-13 days) of a temporary stoma was compared to late closure (> 12 weeks) in the randomized controlled trial EASY (NCT01287637). The study period and follow-up was 12 months after rectal resection. Inclusion of participants was made after index surgery. Exclusion criteria were diabetes mellitus, steroid treatment, signs of postoperative complications or anastomotic leakage. Clinical effectiveness and resource use were derived from the trial and unit costs from Swedish sources. Costs were calculated for the year 2016 and analysed from the perspective of the healthcare sector. RESULTS: Fifty-five patients underwent early closure, and 57 late closure in eight Swedish and Danish hospitals between 2011 and 2014. The difference in mean cost per patient was 4060 US dollar (95% confidence interval 1121; 6999, p value < 0.01) in favour of early closure. A sensitivity analysis, taking protocol-driven examinations into account, resulted in an overall difference in mean cost per patient of $3608, in favour of early closure (95% confidence interval 668; 6549, p value 0.02). The predominant cost factors were reoperations, readmissions and endoscopic examinations. CONCLUSIONS: The significant cost reduction in this study, together with results of safety and efficacy from the randomized controlled trial, supports the routine use of early closure of a temporary ileostomy after rectal resection for cancer in selected patients without signs of anastomotic leakage. CLINICAL TRIAL: Registered at clinicaltrials.gov, clinical trials identifier NCT01287637.

Sexual function after proctectomy in patients with inflammatory bowel disease: A prospective study.

BACKGROUND/AIMS: Inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC) show a multifactorial impact on patients' quality of life, including sexual function (SF). The need for surgical intervention remains high, whereas proctectomy is frequently required in these patients. We tried to evaluate the impact of pelvic dissection during proctectomy in IBD patients' SF. MATERIALS AND METHODS: We conducted a prospective study, examining the pre- and postoperative (at 6 months) SF of 57 IBD patients that underwent proctectomy in our surgical department, in the period between 2010 and 2016. The 5-item International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index were our research tools for men and women, respectively. We tried to evaluate the impact of gender, age, type of the disease, and surgical procedure on postoperative outcome. RESULTS: Ileal pouch-anal anastomosis (IPAA) was offered to 45 patients, whereas 12 patients underwent total proctocolectomy with permanent end ileostomy (TPC). Men showed a non-significant improvement in median IIEF-5 score after proctectomy (22.0 vs 23.0, p=0.152). The majority of men had no erectile dysfunction either before (56.4%) or after (51.3%) surgery (p=0.599). Changes remained insignificant for subgroup analysis according to age, disease and surgical procedure. Female patients had also a non-significant improvement in overall median score (23.0 vs 24.1, p=0.856). Women's score remained below the cut-off value of 26.5 for almost every subgroup analyzed. CONCLUSIONS: Proctectomy did not affect SF of IBD patents six months after surgery. Female patients seem to face more frequently a poor SF compared to men.

A Single-arm, Practical Application Assessment of User Experience and Peristomal Skin Condition Among Persons With an Ileostomy Using a New Barrier Seal With Assisted Flow.

Peristomal skin complications are a common problem for persons with an ileostomy. PURPOSE: The purpose of this pilot study was to solicit user feedback and perform an initial assessment of the performance of a new barrier seal designed to decrease the risk of chemical-induced dermatitis. METHODS: Seven (7) potential participants who were at least 18 years of age, >6 months post surgery, with an end or loop ileostomy and unbroken peristomal skin, and who were capable of changing their appliance themselves or had the availability of care assistance were identified and recruited by the stoma care nurse at the University Hospital, Limerick, Ireland. At the initial visit and after 1 and 2 weeks, participants were asked to rate device comfort, security, and handling; skin condition was assessed by the research nurse using the Ostomy Skin Tool. Descriptive statistics were used to tabulate the results. RESULTS: Five (5) participants completed the study. Discoloration, erosion, and tissue overgrowth scores improved in 3 of 5 patients, and the mean Ostomy Skin Tool score decreased from 5.4 ± 2.19 at the initial assessment to 4 ± 1.87 at the week 2 visit. Comfort, handling, and security ratings increased from a median of 8 at the beginning of the study to 10 at week 2. CONCLUSION: Initial patient feedback regarding the new product was positive, and skin assessment results suggest the new seal may help improve peristomal skin condition. Larger studies with longer patient follow-up are needed to confirm the results of this pilot evaluation.

Overview of psychosocial problems in individuals with stoma: A review of literature.

This literature review was conducted to summarise empirical evidence relating to psychosocial health following ostomy surgery during hospitalisation and after discharge. Both qualitative and quantitative studies were searched from 2000 to 2017 using PubMed, CINAHL, Ebrary, Elsevier, Science Direct, and Scopus. Twenty-seven articles were included that examined the patient's psychosocial health following colostomy or ileostomy surgery. Among the 27 included studies, 11 adopted qualitative research methods and 16 used quantitative designs. Most of the studies were conducted to determine psychosocial problems and emotions of the individuals, their adaptation to the stoma, and their quality of life. Most of the psychosocial problems identified in these studies were poor body image perception and self-respect, depression, sexual problems, and lower psychosocial adaptation. This literature review has illustrated the patient's psychosocial health following stoma surgery. Further studies exploring the effect of psychosocial interventions could be planned.

The embodied experience of pregnancy with an ileostomy.

AIMS AND OBJECTIVES: To understand women's experience of pregnancy with an ileostomy following bowel resection for inflammatory bowel disease or familial adenomatous polyposis. BACKGROUND: While symptoms of IBD/FAP can be debilitating and life-threatening, ostomy formation can effectively manage symptoms. Research on pregnant women with an ostomy is sparse. While some literature suggests pregnant women with an ostomy can have a normal pregnancy and birth, documented stoma complications include intestinal obstruction, peristomal hernia, retraction, stenosis, laceration, bleeding, prolapse, pouching problems, nausea, vomiting and dehydration. DESIGN: Hermeneutic phenomenology. METHODS: All known women (n = 8) who had been pregnant with an ileostomy were recruited from the stomal therapy departments of two teaching hospitals. Single in-depth interviews were digitally recorded and transcribed verbatim. Hermeneutic phenomenological analysis was guided by the philosophy of Merleau-Ponty. Reporting rigour was guided by the consolidated criteria for reporting qualitative research. RESULTS: There was a lower level of concern among pregnant woman with an ostomy than anticipated. Women described the following: the "hell" of the disease; the stoma as a lifeline; heading into uncharted waters; wanting to be normal; the shared space of the baby and the diseased abdomen; pregnancy as a dark tunnel; and the unreliable body. CONCLUSION: Women with inflammatory bowel disease frequently experience debilitating symptoms and serious ill health. Ileostomy formation improves symptoms and the sense of "feeling normal," facilitating readiness for conception, pregnancy and motherhood. However, women's uncertainty about conception and pregnancy persists due to the scarce information and experiences offered by clinicians, and fears around their unreliable body during pregnancy. Given this uncertainty for both women and their treating clinicians, outcomes should be documented and shared to reassure women of child-bearing age that pregnancy and birth can be safe with a stoma. RELEVANCE TO PRACTICE: Women and clinicians should aim for disease remission, peer support, ongoing monitoring and involvement of a Stomal Therapy Nurse.

Psychometric validation of the Stoma-QOL questionnaire in a Canadian cross-sectional sample of colostomy and ileostomy patients.

OBJECTIVES: The Stoma-QOL questionnaire is a patient-reported outcome (PRO) used to measure quality of life in patients with ileostomy or colostomy. This study assesses the Stoma-QOL's overall and item-level psychometric characteristics in patients with temporary stomas, and whether stoma-related quality of life differs by demographic characteristics. MATERIALS AND METHODS: Analysis of cross-sectional observational PRO data from hospitals in Vancouver, Canada. Patients registered for elective ileostomy or colostomy closure, over the age of 18, and able to read English were eligible for participation. Emergent and cancer-related cases were excluded. One-way analysis of variance was used to test for demographic differences in Stoma-QOL scores. Cronbach's alpha was used for reliability, and Rasch item-response theory was used to assess overall and item characteristics. RESULTS: 120 patients were included. No statistically significant difference in Stoma-QOL scores was found by age, sex, or socioeconomic status. Reliability was 0.93. Mean item responses ranged from 1.77 to 3.55 and item-total correlation ranged from 0.51 to 0.77. The Rasch item-response theory model demonstrated significant misfit, likely due to the misfit of item 9, which asks about sexuality, and high residual correlations between item pairs 6 and 8 about fatigue, and items 16 and 17 about social relationships. CONCLUSIONS: The Stoma-QOL questionnaire is a well-designed PRO for measuring stoma-related quality of life. Demographic variables do not appear to have a strong influence on Stoma-QOL scores. Item 9 demonstrated misfit but removal likely does not improve the instrument. Future research should focus on revising items 6, 8, 16, and 17.

The Lived Experiences of Persons Hospitalized for Construction of an Urgent Fecal Ostomy.

PURPOSE: The purpose of this study was to describe the lived experiences of hospital stays for patients undergoing urgent ostomy surgery. DESIGN: Qualitative, descriptive, phenomenological study. SUBJECTS AND SETTING: Six persons undergoing acute hospital admission and urgent ileostomy or colostomy surgery (either permanent or temporary) participated in the study. Participants were of Danish ethnicity and between the ages of 48 and 75 years. The research setting was the surgical department at a university hospital in the Capital Region of Denmark. METHODS: Data collection and analyses were guided by a Reflective Lifeworld Research approach; this approach is based on phenomenological philosophy. Data were collected during in-depth interviews using a semistructured interview guide. Their average length was 50 minutes (range, 30-65 minutes). Interviews were digitally recorded and transcribed. Transcriptions were analyzed in 4 phases according to the principles of Reflective Lifeworld Research. RESULTS: The phenomenon we labeled "lived experiences of acute hospitalization with construction of an urgent unplanned fecal ostomy" comprised 4 constituents: (1) undergoing unexpected bodily changes, (2) partnership with professional caregivers, (3) experience of vulnerability, and (4) a lack of continuity. These constituents can be described as a number of challenges due to both hospitalization and ostomy creation. CONCLUSION: We found that individuals experience a number of challenges due to acute hospitalization and urgent construction of a fecal ostomy. These challenges are due to the unexpected bodily changes and interpersonal and organizational conditions. Nurses should be aware of not only the physical implications of urgent creation of a fecal ostomy but also the individual and psychological implications of this event.

Living with a parastomal bulge - patients' experiences of symptoms.

AIMS AND OBJECTIVES: To investigate experienced symptoms of parastomal bulging in relation to an ileostomy or colostomy. BACKGROUND: Parastomal bulging is a common complication of stoma formation that can affect patients' physical, psychological and social function. Symptom burdens reported by health professionals vary from asymptomatic to high symptom load; however, patients' experiences of symptoms are lacking. DESIGN AND METHOD: A qualitative design with focus group interviews was chosen for data collection. Twenty patients participated in five semi-structured interviews. Analysis was performed using a phenomenological-hermeneutic approach. FINDINGS: The bulge caused different unfamiliar bodily sensations that interacted with patients' everyday lives. Some but not all of these sensations were modifiable. As the bulge and the ostomy changed size and shape, patients had to adjust and readjust stoma care continuously. The physical change called for patients' awareness and posed a threat to patients' control of the ostomy and challenged stoma self-care. The bulge caused a bodily asymmetry that deformed the patients' bodies in a way that exceeded the perceived alteration already caused by the stoma. To cover the physical disfigurement, new clothing solutions, garment wear and creativity were essential in everyday life. Patients gradually adapted to the bulge over time. Easy access to professional help was crucial in order to find the best appliance and garment solution in relation to the bulge. CONCLUSIONS: Various symptoms related to the parastomal bulge affected patients' everyday lives in different ways and underpinned that an individualised approach is important when addressing patients' problems and complaints. Research into nonsurgical treatments and patient perspectives is limited and highly warranted to improve clinical outcome. RELEVANCE TO CLINICAL PRACTICE: The ever-changing bulge posed a threat to patients' control of the ostomy and required specific care from the stoma therapist. Needs-based access to counselling, advice and supplementary materials is important.

Cross-cultural Adaptation and Validation of the Stoma Quality of Life Questionnaire for Patients With a Colostomy or Ileostomy in Brazil: A Cross-sectional Study.

Many studies examining the quality of life of stoma patients utilize questionnaires that have not been validated specifically for these patients in their native language. Owing to the large and increasing prevalence of intestinal stomas, a cross-sectional study was conducted among patients of a stoma patient health care service in Juiz de Fora, Brazil between September 2014 and August 2015 to validate the Stoma Quality of Life (Stoma-QoL) questionnaire in Portuguese (Brazilian variant). In addition, the effect of sociodemographic, clinical, and eating habit variables on the quality of life of people with a colostomy or ileostomy was assessed. Eating habit variables included eating comfort in the postoperative period, excluding foods for a period of time, fear of eating, and excluding foods that may cause odor, gas, diarrhea, and/or constipation. All patients with a colostomy or ileostomy served by 1 ostomy care center were invited to participate. Patients who were at least 18 years of age, provided signed informed consent, and had the physical and mental capacity to complete the questionnaire were eligible to participate. The sociodemographic, clinical history, eating behavior, and Stoma-QoL questionnaires were administered by trained researchers as part of patient nutritional care. A sample of 11 (10% of all study participants) also completed the 12-item Short Form Health Survey (SF-12), which includes a Mental Component Summary (MCS) and a Physical Component Summary (PCS), to establish convergent validity. All participant response data were collected using a standardized form developed for this study and stored in electronic files. The identities of patients were kept anonymous, and patients had the option to refuse to participate during the assessment. Data were analyzed descriptively; the Mann-Whitney and Kruskal-Wallis tests were used to analyze associations among the variables collected. Normal distribution of the Stoma-QoL total scores was assessed using the Kolmogorov-Smirnov test. Internal consistency was assessed as a whole using Cronbach's alpha, and agreement and reproducibility were determined using the intraclass correlation coefficient. Relationships between the Stoma-QoL and the SF-12 items were examined using the Pearson correlation coefficient. The majority of the 111 participants were men (57, 51.4%), most (94, 84.7%) were 50 years of age or older, 70 (63.1%) had a colostomy, and 41 (36.9%) had an ileostomy. Most stomas (79, 71.2%) were created to treat cancer of the colon and rectum. The mean overall Stoma-QoL score for study participants was 58.7 ± SD 12.0 (range 32.0-78.0). The internal consistency of the translated Stoma-QoL was .87, demonstrating a high degree of reliability. The convergent validity of the Stoma-QoL with the SF-12 confirmed higher correlation among the items regarding emotional aspects, mental health, social aspects, and vitality, with a higher correlation with the MCS (r = .52; P = .02) and lower correlation between the PCS and the items that assess general health, functional capacity, physical aspects, and pain (r = .38; P = .04), although both were significant. A moderate and significant association was noted between the questionnaires. Women (P = .02) and patients who deprived themselves of food for a certain period of time had a lower quality of life (P = .05). Persons who excluded foods out of fear of repercussions also had significantly lower QoL scores (P <.001). Colostomy and ileostomy patients had a similar quality of life. This study confirms the Stoma-QoL is a valid research tool for colostomy and ileostomy patients in Brazil. Further studies are recommended in the field of food and nutrition to verify observed concerns related to the eating behavior of intestinal stoma patients and the relationship to their quality of life.

The Experience of Living With an Ileoanal Pouch: An Interpretative Phenomenological Analysis.

The purpose of this study was to explore the lived experiences of individuals living with an ileoanal pouch. A qualitative, phenomenological methodology was used to elicit detailed accounts of the impact of living with an ileoanal pouch. Ten individuals having an ileoanal pouch, formed as a consequence of ulcerative colitis, participated in the study. Semistructured interviews were conducted and analyzed using interpretative phenomenological analysis. The following 4 themes emerged from the analysis: "a flood of emotions"; "changed body image"; "changes in lifestyle"; and "intimacy and sexual relationships." Participants indicated that their quality of life after surgery has improved because they were no longer suffering from the devastating symptoms of ulcerative colitis. However, a considerable number of these participants disclosed that they are still living a restricted lifestyle and reported profound changes not only in their physical self but also in their social and sexual relationships. By acknowledging these experiences, healthcare professionals have the potential to improve the psychological, sexual, and social care that these individuals receive.

Exploration of Health Status, Illness Perceptions, Coping Strategies, Psychological Morbidity, and Quality of Life in Individuals With Fecal Ostomies.

PURPOSE: In a previous paper focusing on the common sense model (CSM) for ostomies in people with inflammatory bowel disease, cancer, and diverticular disease, we reported that (1) illness perceptions were directly related to illness status, and both illness perceptions and coping strategies (maladaptive coping) directly influenced anxiety and depression; (2) self-efficacy and emotion-focused coping style ameliorated depression but not anxiety; and (3) time since surgery was associated with improved health status, a reduction in negative illness perceptions, and increased emotional-focused coping. The purpose of this article was to perform a secondary analysis with the addition of a stoma quality-of-life measure. SUBJECTS AND SETTING: One hundred fifty adults with ostomies (54 males, and 96 females; mean age = 44 years) completed an online survey. DESIGN: Descriptive, cross-sectional, questionnaire-based study. METHODS: Participants completed the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Stoma Quality-of-Life Scale. RESULTS: Using structural equation modeling, the final model provided an excellent fit to the data (χ27 = 19.20, P = .37, χ/N = 1.08, Standardized Root Mean Square Residual (SRMR) <0.03, Steiger-Lind Root Mean Square Error of Approximation (RMSEA) <0.03, Goodness of Fit Index (GFI) >0.98). Extending upon our previous paper, self-efficacy, anxiety, and depression were found to have a significant direct influence on stoma-specific quality of life (ß= .47, P < .001, ß=-.25, P < .001, and ß=-.35, P < .001, respectively). CONCLUSIONS: The findings of this secondary analysis extends our previous report by identifying that, consistent with the CSM, illness status, illness perceptions, and coping influence health-related quality of life via self-efficacy, anxiety, and depression. The results suggest that to improve an individual's quality of life, psychological interventions should target the psychological processes underpinning mental illness and also help develop and maintain an individual's self-efficacy in relation to ostomy care.

The psychological challenges of living with an ileostomy: An interpretative phenomenological analysis.

OBJECTIVES: Ileostomy, in which the small intestine is redirected out of an abdominal wall so that waste is collected using a bag, is used to treat conditions including inflammatory bowel disease and colorectal cancer. This article reports an in-depth idiographic analysis of the experience of living with an ileostomy. METHOD: Twenty-one participants took part in semistructured interviews about their lives and relationships. Those interviews were transcribed verbatim and analyzed using the experiential qualitative methodology interpretative phenomenological analysis. RESULTS: Two superordinate themes arose from the data: ileostomy's intrapersonal impact and the impact of ileostomy on relationships with others. The authors found that ileostomy may destabilize the sense of self, disrupt body image, and alter experience of age and sexuality. Other participants were able to use their illness to positively reframe the self. Disclosure of ileostomy status was difficult for some. Intimate and friend relationships were often challenged by stoma status, whereas other family relationships were largely characterized as supportive. CONCLUSIONS: Ileostomy may impact upon both intra- and interpersonal aspects of the lives of those who live with it, in both negative and positive ways. Consequently, the sense of self can appear challenged, and relationships with partners, family members and friendships could be causes of distress. On the other hand, some partners were supportive, and children were found to be sources of comfort. (PsycINFO Database Record